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  • Fan, Yuxin; Wang, Leishen; Liu, Huikun; Zhang, Shuang; Tian, Huiguang; Shen, Yun; Tuomilehto, Jaakko; Yu, Zhijie; Yang, Xilin; Hu, Gang; Liu, Ming (2020)
    Introduction To evaluate the single association of postpartum beta-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum beta-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk. Research design and methods The study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of beta-cell secretory function (HOMA-%beta) and homeostatic model assessment of insulin resistance (HOMA-IR). Results Multivariable-adjusted ORs of diabetes across quartiles of HOMA-%beta and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (p(trend) Conclusions beta-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and beta-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.
  • Raitio, Arimatias; Lahtinen, Asta; Syvanen, Johanna; Kemppainen, Teemu; Löyttyniemi, Eliisa; Gissler, Mika; Hyvärinen, Anna; Helenius, Ilkka (2020)
    Introduction The study aims to assess the changes in prevalence and mortality of gastroschisis, and to identify associated anomalies. Materials and Methods It is a population-based nationwide study. All gastroschisis cases were identified in the Finnish Register of Congenital Malformations and the Care Register for Health Care from 1993 to 2014 including live births, stillbirths, and terminations of pregnancy due to fetal anomalies. Associated anomalies were recorded, and analyzed, and prevalence and infant mortality were calculated. Results There were 320 cases of gastroschisis; 235 (73%) live births, 16 (5%) stillbirths, and 69 (22%) terminations of pregnancy. Live birth prevalence of gastroschisis in Finland was lower than generally reported (1.73 in 10,000). However, due to relatively high rates of abortion, our total prevalence of 2.57/10,000 was similar with other reports. The most common risk factor was young maternal age. Babies with gastroschisis were born prematurely, on average on the 36th week and most are delivered by caesarean section. There was a significant increasing trend in live birth prevalence ( p =0.0018). Overall infant mortality was 7.7% (18/235), 7.2% (16/222) in simple gastroschisis and 15% (2/13) in complex gastroschisis. Associated anomalies were rare both in aborted fetuses and neonates, and there was only one case with a chromosomal abnormality. Conclusion Gastroschisis is usually an isolated anomaly with increasing birth prevalence and excellent survival rates. Regardless of the good prognosis, the abortion rates in Finland are higher than previously reported, and we hypothesize this to be due to lack of appropriate antenatal counselling.
  • Koivusalo, Saila B.; Rönö, Kristiina; Klemetti, Miira M.; Roine, Risto P.; Lindstrom, Jaana; Erkkola, Maijaliisa; Kaaja, Risto J.; Pöyhönen-Alho, Maritta; Tiitinen, Aila; Huvinen, Emilia; Andersson, Sture; Laivuori, Hannele; Valkama, Anita Johanna; Meinila, Jelena; Kautiainen, Hannu; Eriksson, Johan G.; Stach-Lempinen, Beata (2016)
    OBJECTIVE To assess whether gestational diabetes mellitus (GDM) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease. RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and/or a prepregnancy BMI of >= 30 kg/m(2) were enrolled in the study at RESULTS A total of 269 women were included in the analyses. The incidence of GDM was 13.9% in the intervention group and 21.6% in the control group ([95% CI 0.40-0.98%]; P = 0.044, after adjustment for age, prepregnancy BMI, previous GDM status, and the number of weeks of gestation). Gestational weight gain was lower in the intervention group (20.58 kg [95% CI 21.12 to 20.04 kg]; adjusted P = 0.037). Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group. CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39% in high-risk pregnant women. These findings may have major health consequences for both the mother and the child.
  • Shen, Yun; Wang, Peng; Wang, Leishen; Zhang, Shuang; Liu, Huikun; Li, Weiqin; Li, Nan; Li, Wei; Leng, Junhong; Wang, Jing; Tian, Huiguang; Zhang, Cuilin; Tuomilehto, Jaakko; Yang, Xilin; Yu, Zhijie; Hu, Gang (2018)
    Aims: To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy. Subjects and methods: Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization's criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results: During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% Cl: 23.6-246) for diabetes and 25.4 (95% CI: 18.2-35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 121 diabetes and 616 prediabetes cases were identified. Women with prior GDM had a 13.0-fold multivariable-adjusted risk (95% CI: 5.54-30.6) for diabetes and 2.15-fold risk (95% CI: 1.76-2.62) for prediabetes compared with women without GDM. The positive associations between GDM and the risks of postpartum diabetes and prediabetes were significant and persistent when stratified by younger and older than 30 years at delivery and normal weight and overweight participants. Conclusions: The present study indicated that women with prior GDM had significantly increased risks for postpartum diabetes and prediabetes, with the highest risk at the first 3-4 years after delivery, compared with those without GDM.
  • Hauta-alus, Helena H.; Viljakainen, Heli T.; Holmlund-Suila, Elisa M.; Enlund-Cerullo, Maria; Rosendahl, Jenni; Valkama, Saara M.; Helve, Otto M.; Hytinantti, Timo K.; Mäkitie, Outi M.; Andersson, Sture (2017)
    Background: Maternal vitamin D status has been associated with both gestational diabetes mellitus (GDM) and fetal growth restriction, however, the evidence is inconsistent. In Finland, maternal vitamin D status has improved considerably due to national health policies. Our objective was to compare maternal 25-hydroxy vitamin D concentrations [25(OH)D] between mothers with and without GDM, and to investigate if an association existed between maternal vitamin D concentration and infant birth size. Methods: This cross-sectional study included 723 mother-child pairs. Mothers were of Caucasian origin, and infants were born at term with normal birth weight. GDM diagnosis and birth size were obtained from medical records. Maternal 25(OH)D was determined on average at 11 weeks of gestation in pregnancy and in umbilical cord blood (UCB) at birth. Results: GDM was observed in 81 of the 723 women (11%). Of the study population, 97% were vitamin D sufficient [25(OH)D >= 50 nmol/L]. There was no difference in pregnancy 25(OH)D concentration between GDM and non-GDM mothers (82 vs 82 nmol/L, P = 0.99). Regression analysis confirmed no association between oral glucose tolerance test results and maternal 25(OH)D (P > 0.53). Regarding the birth size, mothers with optimal pregnancy 25(OH)D (>= 80 nmol/L) had heavier newborns than those with suboptimal pregnancy 25(OH)D (P = 0.010). However, mothers with optimal UCB 25(OH) D had newborns with smaller head circumference than those with suboptimal 25(OH)D (P = 0.003), which was further confirmed as a linear association (P = 0.024). Conclusions: Maternal vitamin D concentration was similar in mothers with and without GDM in a mostly vitamin D sufficient population. Associations between maternal vitamin D status and birth size were inconsistent. A sufficient maternal vitamin D status, specified as 25(OH)D above 50 nmol/L, may be a threshold above which the physiological requirements of pregnancy are achieved.
  • Jalasto, Juuso; Lassmann-Klee, Paul; Schyllert, Christian; Luukkonen, Ritva; Meren, Mari; Larsson, Matz; Põlluste, Jaak; Sundblad, Britt-Marie; Lindqvist, Ari; Krokstad, Steinar; Kankaanranta, Hannu; Kauppi, Paula; Sovijärvi, Anssi; Haahtela, Tari Markku Kallevi; Backman, Helena; Lundbäck, Bo; Piirilä, Päivi (2022)
    Objective: To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases. Methods: In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (FENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined. Results: COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07-9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14-4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For FENO, no associations with occupation were observed. Conclusions: In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased FENO. Keywords: Asthma; COPD; Fraction of exhaled nitric oxide (FENO); Occupational exposure; Smoking; Socioeconomic status.
  • Lassmann-Klee, Paul; Piirilä, Päivi L.; Brumpton, Ben; Larsson, Matz; Sundblad, Britt-Marie; Põlluste, Jaak; Juusela, Maria; Rouhos, Annamari; Meren, Mari; Lindqvist, Ari; Kankaanranta, Hannu; Backman, Helena; Langhammer, Arnulf; Ronmark, Eva; Lundbäck, Bo; Sovijärvi, Anssi (2020)
    The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by FENO measurements. We aimed to compare FENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases. We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and Örebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed FENO (n = 1498) and skin prick tests (SPT) in 1997–2003. The median (interquartile range) of FENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median FENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with FENO ≥25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29–6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02–5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04–6.02), Narva OR 2.45 (1.05–6.19), Örebro OR 3.38 (1.59–8.09), and Stockholm OR 5.54 (2.18–14.79). There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated FENO level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.